Community Health Outreach Research Articles

The Construct of Sex Work in France: A Qualitative Analysis of the Development of a Sex Work Policy

This paper aims to shed light on the particular development of repressive policies on sex work in France. The analysis draws on two main datasets: ongoing research on humanitarian interventions and interviews with insti-tutional, mainstream feminists and other neo-abolitionist groups in Paris and Marseille. The analysis is supported by the ethnographic data emerging from interviews with street- and internet-based migrant workers and key informants, such as community health outreach workers, social workers, and immigration lawyers, in Paris. This analysis argues that the construction of prostitution as a social problem ought to be seen in light of broader political anxieties over sexist behaviour in poor neighbourhoods and immigration control.

Cervical cancer knowledge and screening uptake by marginalized population of women in inner-city Durban, South Africa: Insights into the need for increased health literacy.

Background:Cervical cancer in South Africa accounts for 15.85% of all female cancers and 30.29% of African female cancers, resulting in over 5000 deaths annually. South Africa’s proposed move towards universal healthcare places emphasis on health promotion through education and screening, but there is little data on the baseline levels of knowledge and screening uptake regarding cervical cancer. This study explored the levels of knowledge and screening rates of cervical cancer among vulnerable women living in the inner-city of Durban, South Africa.Methods:A mixed-method study was conducted within the context of a Women’s Health outreach initiative. Data were collected from women attending the outreach (n = 109), many of whom were from marginalized communities. A pre-intervention survey was used to collect the data. This was followed by cervical cancer education sessions and the opportunity for a free Pap smear.Results:Knowledge of cervical cancer was low (<25%) and only a third of the women had previously been screened. After the educational sessions, 64% of women (n = 70) took advantage of the opportunity for Pap smears, with many expressing the need for wider cervical cancer education, screening centres and support groups. Only 20% of the Pap smears were normal (n = 14). Half of the women tested positive for infections (n = 36; 51.4%), and a small proportion (n = 8; 11.4%) tested positive for human papilloma virus. Abnormal cervical intra-epithelial neoplasia (CIN1 and CIN 2) were also detected in this population (n = 12; 17.1%).Conclusion:Cervical cancer knowledge and screening among vulnerable women in Durban, South Africa, is inadequate, especially considering the high levels of abnormality found in the Pap smears. Education drives, accompanied with the provision of free testing, are required. Community health outreach initiatives in collaboration with non-government organizations set in accessible locations could be a possible course of action.

Interprofessional Collaboration to Promote Culturally Engaged and Strengths-Based Practice

Purpose To effectively prepare students to engage in interprofessional practice, a number of Communication Disorders (COMD) programs are designing new courses and creating additional opportunities to develop the interprofessional competencies that will support future student success in health and education-related fields. The ECHO (Educational Community Health Outreach) program is one example of how the Rongxiang Xu College of Health and Human Services at California State University, Los Angeles, has begun to create these opportunities. The ultimate goal of the ECHO project is to increase both access to and continuity of oral health care across communities in the greater Los Angeles area. Method We describe this innovative interdisciplinary training program within the context of current interprofessional education models. First, we describe the program and its development. Second, we describe how COMD students benefit from the training program. Third, we examine how students from other disciplines experience benefits related to interprofessional education and COMD. Fourth, we provide reflections and insights from COMD faculty who participated in the project. Conclusions The ECHO program has great potential for continuing to build innovative clinical training opportunities for students with the inclusion of Child and Family Studies, Public Health, Nursing, and Nutrition departments. These partnerships push beyond the norm of disciplines often used in collaborative efforts in Communication Sciences and Disorders. Additionally, the training students received with ECHO incorporates not only interprofessional education but also relevant and important aspects of diversity and inclusion, as well as strengths-based practices.

Concept analysis of community health outreach

BackgroundThe definition of community health outreach to promote the health of vulnerable populations depends heavily on the particulars of the given health project and community. There is no consistency in the definitions attached to the concept itself. Our study aimed to clarify the general definition of community health outreach to facilitate its understanding and use.MethodsWalker and Avant’s (2010) method of concept analysis was used to understand community health outreach. A total of 45 articles were included in the analysis after having searched for text on database portals like PubMed, Scopus, CINAHL complete and EMBASE published between 2010 and 2018.ResultsThe defining attributes of the concept of community health outreach were purposive, temporary, mobile and collaboration with community. The antecedents were population facing health risks and awareness of health risks. The consequences were increased accessibility and health promotion.ConclusionThis study proposed the definition of community health outreach as a temporary, mobile project that involves the collaboration of a community to undertake its purposeful health intervention of reaching a population facing health risks. This definition provides a general understanding of the outreach undertaken by health workers and enables the strong connection between health professionals and community residents.

An Approach to Outpatient Screening, Treatment, and Community Health Outreach during the Coronavirus Epidemic in New York City

The emergence of the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) pneumonia, also referred to as COVID-19 in New York City in March 2020, has put an overwhelming strain on the healthcare system in the city. Many local hospitals have reported a surge of cases, with most cases presenting with severe respiratory complications. We aim to present a comprehensive surge filter protocol for outpatient programs to mitigate the surge of cases admitted in the emergency rooms and intensive care units (ICUs) of local hospitals in our community. Our surge filter protocol was developed based on a detailed review of how South Korea and Spain mounted their outpatient surge responses. Our preliminary findings revealed that our Four-Ts approach (i.e., Test, Treat, Track, and Teach) has resulted in none of our patients reaching a clinical requirement for inpatient care.

Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians' Perspectives.

Evidence shows community health workers (CHWs) can effectively deliver proven behavior-change strategies to prevent type 2 diabetes mellitus (diabetes) and enhance preventive care efforts in primary care for minority and low-income populations. However, operational details to integrate CHWs into primary care practice remain less well known. To examine clinicians' perceptions about working with CHWs for diabetes prevention in safety-net primary care. Clinicians are primary care physicians and nurses at two New York City safety-net hospitals participating in CHORD (Community Health Outreach to Reduce Diabetes). CHORD is a cluster-randomized trial testing a CHW intervention to prevent diabetes. Guided by the Consolidated Framework for Implementation Research, we studied how features of the CHW model and organizational context of the primary care practices influenced clinicians' perspectives about the acceptability, appropriateness, and feasibility of a diabetes-prevention CHW program. Data were collected pre-intervention using semi-structured interviews (n = 18) and a 20-item survey (n = 54). Both survey and interview questions covered clinicians' perspectives on diabetes prevention, attitudes and beliefs about CHWs' role, expectations in working with CHWs, and use of clinic- and community-based diabetes-prevention resources. Survey responses were descriptively analyzed. Interviews were coded using a mix of deductive and inductive approaches for thematic analysis. Eighty-seven percent of survey respondents agreed CHWs could help in preventing diabetes; 83% reported interest in working with CHWs. Ninety-one percent were aware of clinic-based prevention resources; only 11% were aware of community resources. Clinicians supported CHWs' cultural competency and neighborhood reach, but expressed concerns about the adequacy of CHWs' training; public and professional emphasis on diabetes treatment over prevention; and added workload and communication with CHWs. Clinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs' effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care.

Influence of Households’ Socio-Economic and Demographic Characteristics on Morbidity and Nutritional Status of Preschool Children in Ganze- Kilifi County, Kenya

ABSTRACT: Globally, socio economic and demographic status of households have been shown to influence the health of school children. However, knowledge of the impact of these factors on children’s health is scarce in Kilifi County. This study evaluated the influence of households’ socio-economic and demographic characteristics on Preschool children’s morbidity and nutritional status in Ganze Kilifi County, Kenya. A total of 288 pre-school children (3-5 years) and their households were selected from ten Government schools five which had a school lunch programme (study group) and five without the programme (Control group) but in the same locality. Households’ socioeconomic and demographic data was collected by trained research assistants using pretested questionnaires. WHO Anthro programme was used to evaluate children’s nutritional status and SPSS version 24, and SAS version 9.4 statistical software for Data analysis. The threshold for statistical significance was set at p&lt;0.05. Household heads with no formal education were 30% and the average income of the households was KES. 3000-5000 per month. Households’ average daily allocation to food was Kes.100-150. Children enrollment in preschool was 65% for boys and girls 35%. Children who were sick two weeks, prior to the interview were 2 times more likely to be stunted [OR=2.20; 95%CI=1.25 - 3.85; P=0.006] and 2.5 times more likely to be underweight [OR=2.66; 95%CI=1.48 - 4.77; P=0.001] compared to children without sickness. This study found that socio economic and demographic factors influenced morbidity and nutritional status of the preschool children. The study showed that the long distance to health services, low education level and income contributed to increased ill health and morbidity resulting into stunted and underweight children. The study recommends that the relevant authorities should improve access to clean water and sanitation in addition to community health outreach services targeting the children. Also, the community should be supported and encouraged to engage in income generating activities for economic empowerment.

USING ECHO TO SUPPORT DEMENTIA DIAGNOSIS IN THE PRIMARY CARE NETWORK

Approximately 60% of those with dementia do not carry a diagnosis, undermining patient participation in clinical trials and family access to support. Under-diagnosis is driven by lack of knowledge about dementia, stigma, clinician inexperience and therapeutic nihilism. To address clinician-based contributors to under-diagnosis, we developed and implemented “Dementia 360,” a telementoring program modeled on the ECHO (Extension for Community Health Outreach) framework. Remote participants (n=67) learned about the diagnostic process, pharmacological management, family support and dementia-related resources. The video-conference-based one-hour sessions occurred weekly over 2 months. Instruction was provided by a multi-disciplinary faculty team with extensive clinical experience. Didactic presentations were followed by case studies offered by participants. Physicians, nurses, psychologists and social workers from 40 organizations participated, of which 62% were from medically underserved rural clinics. Participants were administered pre- and post-program questionnaires about their level of confidence in assessing and treating individuals with memory loss and dementia-related behavioral symptoms. Of the 54 clinicians who completed pre-intervention confidence assessments, 30 completed post-assessment. The clinicians had significantly increased confidence in diagnosing and treating dementia and managing behavioral symptoms of dementia (p ranging from .0002 to .003). Qualitative feedback from focus groups was generally positive, for example, “Knowing the diagnosis criteria and steps to take to rule out other diagnoses will help me more accurately diagnose and rule out dementia for my patients.” Our findings suggest that delivering case-based education via ECHO has potential to increase clinician workforce confidence in diagnosing and managing dementia.

Accessing public healthcare in Oslo, Norway: the experiences of Thai immigrant masseuses

BackgroundThai massage is a highly gendered and culturally specific occupation. Many female Thai masseuses migrate to Norway as marriage migrants and as such are entitled to the same public healthcare as Norwegian citizens. Additionally, anyone who is not fluent in Norwegian is entitled to have an interpreter provided by the public healthcare system. Norway and most other countries aspire to universal health coverage, but certain immigrant populations continue to experience difficulties accessing appropriate healthcare. This study examined healthcare access among Thai migrant masseuses in Oslo.MethodsGuided by access to healthcare theory, we conducted a qualitative exploratory study in 2018 with Thai women working as masseuses in Oslo, Norway. Through semi-structured in-depth interviews with 14 Thai women, we explored access to healthcare, health system navigation and care experiences. We analyzed the data using thematic analysis and grouped the information into themes relevant to healthcare access.ResultsParticipants did not perceive that their occupation limited their access to healthcare. Most of the barriers participants experienced when accessing care were related to persistent language challenges. Women who presented at healthcare facilities with their Norwegian spouse were rarely offered interpreters, despite their husband’s limited capacity to translate effectively. Cultural values inhibit women from demanding the interpretation services to which they are entitled. In seeking healthcare, women sought information about health services from their Thai network and relied on family members, friends and contacts to act as informal interpreters. Some addressed their healthcare needs through self-treatment using imported medication or sought healthcare abroad.ConclusionsDespite having the same entitlements to public healthcare as Norwegian citizens, Thai migrants experience difficulties accessing healthcare due to pervasive language barriers. A significant gap exists between the official policy that professional interpreters should be provided and the reality experienced by study participants. To improve communication and equitable access to healthcare for Thai immigrant women in Norway, health personnel should offer professional interpreters and not rely on Norwegian spouses to translate. Use of community health workers and outreach through Thai networks, may also improve Thai immigrants’ knowledge and ability to navigate the Norwegian healthcare system.

Erratum: Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut.

Erratum: Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut.

Protocol for the CHORD project (community health outreach to reduce diabetes): a cluster-randomized community health worker trial to prevent diabetes

BackgroundType 2 diabetes mellitus (DM) affects 9.4% of US adults and children, while another 33.9% of Americans are at risk of DM. Health care institutions face many barriers to systematically delivering the preventive care needed to decrease DM incidence. Community health workers (CHWs) may, as frontline public health workers bridging clinic and community, help overcome these challenges. This paper presents the protocol for a pragmatic, cluster-randomized trial integrating CHWs into two primary care clinics to support DM prevention for at-risk patients.MethodsThe trial will randomize 15 care teams, stratified by practice site (Bellevue Hospital and Manhattan VA), totaling 56 primary care physicians. The study cohort will consist of ~ 2000 patients who are 18–75 years of age, actively enrolled in a primary care team, able to speak English or Spanish, and have at least one glycosylated hemoglobin (HbA1c) result in the prediabetic range (5.7–6.4%) since 2012. Those with a current DM diagnosis or DM medication prescription (other than metformin) are ineligible. The intervention consists of four core activities – setting health goals, health education, activation for doctor’s appointments, and referrals to DM prevention programs – adjustable according to the patient’s needs and readiness. The primary outcome is DM incidence. Secondary outcomes include weight loss, HbA1C, and self-reported health behaviors. Clinical variables and health behaviors will be obtained through electronic medical records and surveys, respectively. Implementation outcomes, namely implementation fidelity and physicians’ perspectives about CHW integration into the clinic, will be assessed using interviews and CHW activity logs and analyzed for the influence of moderating organizational factors.DiscussionThis is the first rigorous, pragmatic trial to test the effectiveness of integrating CHWs into primary care for DM prevention reaching a population-based sample. Our study’s limitations include language-based eligibility and the use of HbA1c as a measure of DM risk. It will measure both clinical and implementation outcomes and potentially broaden the evidence base for CHWs and patient-centered medical home implementation. Further, the intervention’s unique features, notably patient-level personalization and referral to existing programs, may offer a scalable model to benefit patients at-risk of DM.Trial Registration.Clinicaltrials.gov NCT03006666 (Received 12/27/2016).

Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut.

BackgroundNon-communicable diseases, mainly cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, are responsible for approximately 63% of all deaths occurring worldwide in any given year. The majority of these deaths have occurred in low- and middle-income countries (LMICs). The latest World Health Organization (WHO) report shows that the increase in diabetes is also most pronounced in the LMICs. The South African Labour and Development Research Unit estimated a 9% prevalence within the adult population in 2016. In the Eastern Cape Province, hypertensive heart disease has become the second most common cause of death, followed by diabetes, the third most common cause of death.Aim and settingThe aim of this study was to report on the follow-up of patients in the community with known hypertension or diabetes or who were deemed at-risk (as identified during a prior community-wide survey).MethodsData were collected via a household primary health screening, monitoring and follow-up process, which included taking anthropometric measurements, blood pressure (BP) and blood glucose and referring to clinics for further testing and treatment where necessary.ResultsOf the 1885 participants followed up by the community health outreach workers, 1702 were known to be hypertensive and 183 were deemed at-risk [of these, only 24 (13.2%) had normal or high normal systolic BP readings]. There were 341 participants with diabetes and 34 at-risk of diabetes [of these, 28 (82%) had levels of 11 mmol/l or higher at follow-up]. There was a significant improvement in BP and glucose control over repeated visits.ConclusionIn this rural area of the Eastern Cape, South Africa, the follow-up of patients with hypertension or diabetes as well as those individuals at-risk adds value to hypertension and glucose control.

Seroprevalence of HCV and HIV infection among clients of the nation’s longest-standing statewide syringe exchange program: A cross-sectional study of Community Health Outreach Work to Prevent AIDS (CHOW)

BackgroundThe Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. MethodsA cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. ResultsThe estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI]=59.5–75.8%). HIV seroprevalence was 2.3% (95% CI=0–4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR]=1.03; 95% CI=1.02–1.05) and months exchanging syringes (quartiles) (APPR=1.92; 95% CI=1.3–3.29) were independently associated with anti-HCV prevalence. ConclusionIn Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

Social and Environmental Justice as a Lens to Approach the Distribution of $105 Million of Directed Funding in Response to the Deepwater Horizon Oil Disaster

Abstract We describe the underlying role of environmental and social justice concepts in the development of the Gulf Region Health Outreach Program (GRHOP), an ongoing 5-year, $105 million community health program funded through the medical settlement of the Deepwater Horizon (DWH) oil spill. The DWH oil spill affected a broad area of the Gulf Coast, causing direct health, social, environmental, and economic effects. The affected communities have health statistics that is among the poorest in the nation, and had previously been battered and disrupted by natural disasters. A major toxic tort law suit ensued. Included in this $7.6 billion settlement was a unique provision for a community health outreach program to expand and improve access to healthcare in underserved areas; address behavioral and mental health needs; train community health workers; and expand and improve environmental health expertise, capacity, and literacy. The settlement specified the 17 counties and parishes in four states for GRHOP ac...

Advancing Women's Health in India: RAD-AID's Approach to Nursing Education, Mobile Imaging, and Community Health Outreach

RAD-AID International, a nonprofit in official relations with the World Health Organization, works to advance women's health in India through a mobile imaging program called Asha Jyoti and provides cervical, breast, and osteoporosis screenings for women with little or no access to radiology. This article discusses Asha Jyoti's recent expansion and the incorporation of a community health nursing education program to further support the growing demands and challenges faced in providing community health outreach in India.

Preventing the September Epidemic through a Multi-Faceted Approach

Background: The "September Epidemic" is a well-known phenomenon: there is an increased likelihood of asthma exacerbations among children during the first month of school. Likely triggers include a combination of factors such as the stress of starting a new school year, the exposure to classrooms and respiratory viruses from fellow classmates, and concurrent weather patterns due to a change in season.Furthermore, as many children with a known history of asthma experience a decrease in symptoms during the preceding summer, there has been some concern that children and families are less aware of their likely triggers and less likely to be prescribed and to purchase their preventive therapy (controller medication).Clalit Health Services (CHS), a payer/provider health service organization servicing over 4 million members, in concert with the Clalit Research Institute which accesses the CHS database that coordinates the comprehensive and universally adopted medical record system of CHS, set about to develop a program that would integrate two otherwise independent components: a child's electronic medical record (including diagnoses, admissions, and pharmacy records) that indicated a child is at risk and the CHS community health outreach infrastructure (newsletters to parents, nursing coordinator outreach, district level medical director) that could schedule appointments for consideration of controller medication.Methods: We identified the precise weeks during which the September Epidemic was most severe over the past five years. Then, we analyzed and described an annual effect that patients with moderate asthma were unlikely to use preventive therapy in the weeks and months preceding September. We identified which children had not purchased preventive therapy as of the end of July 2015, and implemented a simultaneous outreach at three levels: responsible guardian with a registered email, nursing coordinator outreach, district level medical director. A short memo was sent to each of the three levels, describing the phenomenon, the risk factors, and the possible avenues for intervention. A list of children was provided to the nursing coordinator for direct contact to responsible guardian and to the medical director for distribution to the responsible clinicians. Primary care providers were encouraged to review their children's medical records and consider prescribing controller medication for initiation prior to the start of the new school year (September 1st).Conclusion: A payer/provider system is well positioned to use data-driven findings to inform and drive a targeted invention. Designating how to measure and evaluate the impact and outcomes of the intervention is an important and complex stage in the planning process, especially when common signs of health care use (like physician visits) can be signs both of the intervention (increase in preventive visits) and of the outcome (decrease in emergency visits). The results from the success of the implementation of this intervention and the impact it has on patient outcomes and health care utilization will be of critical importance when advocating for support from key-stakeholders for future iterations of such a model.

Improving early childhood care and development, HIV-testing, treatment and support, and nutrition in Mokhotlong, Lesotho: study protocol for a cluster randomized controlled trial.

BackgroundSince 1990, the lives of 48 million children under the age of 5 years have been saved because of increased investments in reducing child mortality. However, despite these unprecedented gains, 250 million children younger than 5 years in low- and middle-income countries (LMIC) cannot meet their developmental potential due to poverty, poor health and nutrition, and lack of necessary stimulation and care. Lesotho has high levels of poverty, HIV, and malnutrition, all of which affect child development outcomes. There is a unique opportunity to address these complex issues through the widespread network of informal preschools in rural villages in the country, which provide a setting for inclusive, integrated Early Childhood Care and Development (ECCD) and HIV and nutrition interventions.MethodsWe are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention program to integrate HIV-testing and treatment services, ECCD, and nutrition education for caregivers with children aged 1–5 years living in rural villages. Caregivers and their children are randomly assigned by village to intervention or control condition. We select, train, and supervise community health workers recruited to implement the intervention, which consists of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top-up session 1 month later), followed by a locally hosted community health outreach day event. Group-based sessions focus on using early dialogic book-sharing to promote cognitive development and caregiver-child interaction, health-related messages, including motivation for HIV-testing and treatment uptake for young children, and locally appropriate nutrition education. All children aged 1–5 years and their primary caregivers living in study villages are eligible for participation. Caregivers and their children will be interviewed and assessed at baseline, after completion of the intervention, and 12 months post intervention.DiscussionThis study provides a unique opportunity to assess the potential of an integrated early childhood development intervention to prevent or mitigate developmental delays in children living in a context of extreme poverty and high HIV rates in rural Lesotho. This paper presents the intervention content and research protocol for the study.Trial registrationThe Mphatlalatsane: Early Morning Star trial is registered on the International Standard Randomized Controlled Trial Number database, registration number ISRCTN16654287; the trial was registered on 3 July 2015.

Health Info on the Go!

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsNora KaturakesNora C. Katurakes, RN, MSN, OCN, is the manager of Community Health Outreach and Education, and Charlene W. Marinelli, RN, BSN, OCN, is a screening nurse navigator at the Helen F. Graham Cancer Center and Research Institute at Christiana Care Health System, Newark, Del.Charlene MarinelliNora C. Katurakes, RN, MSN, OCN, is the manager of Community Health Outreach and Education, and Charlene W. Marinelli, RN, BSN, OCN, is a screening nurse navigator at the Helen F. Graham Cancer Center and Research Institute at Christiana Care Health System, Newark, Del.

Screening for Antepartum Depression Through Community Health Outreach in Swaziland.

Maternal depression, including antepartum and postpartum depression, is a neglected public health issue with potentially far-reaching effects on maternal and child health. We aimed to measure the burden of antepartum depression and identify risk factors among women in a peri-urban community in Swaziland. We conducted a cross-sectional study within the context of a community outreach peer support project involving "Mentor Mothers". We used of the Edinburgh Postnatal Depression Scale (EPDS) to screen women for depression during the third trimester of pregnancy, using a cut-off score of ≥13 to indicate depression. We also collected demographic and socioeconomic factors, and assessed the association of these factors with EPDS score using logistic regression models. A total of 1038 pregnant women were screened over a period of 9months. Almost a quarter (22.7%) had EPDS scores ≥13 and 41.2% were HIV positive. A fifth, 17.5% were teenagers and 73.7% were unemployed. Depression was not associated with HIV status, age or employment status. However, women with multiple socioeconomic stressors were found to be more likely to score highly on the EPDS. Depression was common among pregnant women in the peri-urban areas of Swaziland. Screening for depression using the EPDS is feasible and can be included in the community health worker standard tool box as a way to improve early detection of depression and to highlight the importance of maternal mental health as a core public health concern.

Reproductive, Maternal, Newborn, and Child Health in the Community: Task-sharing Between Male and Female Health Workers in an Indian Rural Context.

Background:Male community health workers (CHWs) have rarely been studied as an addition to the female community health workforce to improve access and care for reproductive, maternal, newborn, and child health (RMNCH).Objective:To examine how male health activists (MHAs) coordinated RMNCH responsibilities with existing female health workers in an Indian context.Materials and Methods:Interviews from male and female CHWs were coded around community-based engagement, outreach services, and links to facility-based care.Results:Community-based engagement: MHAs completed tasks both dependent and independent of their gender, such as informing couples on safe RMNCH care in the antenatal and postnatal periods. MHAs motivated males on appropriate family planning methods, demonstrating clear gendered responsibility. Outreach services: MHAs were most valuable traveling to remote areas to inform about and bring mothers and children to community health events, with this division of labor appreciated by female health workers. Link to facility-based services: MHAs were recognized as a welcome addition accompanying women to health facilities for delivery, particularly in nighttime.Conclusion:This study demonstrates the importance of gendered CHW roles and male-female task-sharing to improve access to community health events, outreach services, and facility-based RMNCH care.